Provider Demographics
NPI:1558428359
Name:EWEN, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:EWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4277
Mailing Address - Street 2:2580 BYPASS ROAD
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-4277
Mailing Address - Country:US
Mailing Address - Phone:859-745-3060
Mailing Address - Fax:859-745-0885
Practice Address - Street 1:2580 BYPASS ROAD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40392
Practice Address - Country:US
Practice Address - Phone:859-745-3060
Practice Address - Fax:859-745-0885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0800034OtherUNITED HEALTHCAR OF KY
KY64251903Medicaid
5318116OtherAETNA
000000048926OtherANTHEM
611120291OtherHUMANA
180022279OtherMEDICARE RAILROAD
K010233OtherCHAMPUS
611120291OtherCHA HEATH
1450480OtherUNITED MINE WORKERS
KY3406OtherBCBS OF KY
611120291OtherBLUEGRASS HEALTHCARE ALLI
C76082OtherBLUEGRASS FAMILY HEALTH